Health and Disability

A bipartisan group of federal lawmakers is seeking to increase the number of people who can remain in their homes thanks to the Medicare Program of All-Inclusive Care for the Elderly (PACE), introducing a bill in the U.S. House of Representatives to expand that program.

The PACE program is designed to enable seniors who need a nursing home level of care to instead remain at home or in a community-based setting, by providing more flexibility than traditional fee-for-service Medicare and Medicaid rules allow. Under PACE, rather than entering an institution, a beneficiary can receive coordinated care through an interdisciplinary team of providers. There currently are 114 PACE programs in 32 states.

The PACE Innovation Act of 2015—introduced Tuesday in the House—would allow certain individuals who are younger than 55 to participate in the program, as well as other groups who are deemed likely to benefit from taking part.

“The PACE program continues to be a comprehensive, provider-based health plan with a proven track record of high quality care for seniors while enabling them to live independently at home,” said co-sponsor Rep. Chris Smith (R-N.J.). “PACE significantly boosts the quality of life for the seniors it currently serves and my legislation would broaden eligibility so more individuals can get the help they need—at a time it could be even more beneficial.”

1. Can I get dental coverage through the Marketplace? In the Marketplace, dental coverage is included in some health plans. You can also get a stand-alone plan and pay a separate premium.

2. How do I add dental coverage to my Marketplace plan? You can buy a dental plan through the federal Marketplace only when you enroll in a health plan at the same time. If you’re already enrolled in a Marketplace plan, you can’t add on dental coverage. You have to wait until the next Open Enrollment Period to change health plans to one that includes dental coverage or add a stand-alone dental plan. If you qualify for a Special Enrollment Period, you can get dental coverage when you change health plans.

3. How can I see what dental plans and benefits are available? After you complete your Marketplace application and get your results, you can view health plans that include dental coverage. If you decide you want a stand-alone dental plan, you can choose one after you select your health plan.

The combined study results showed that the consumption of B-GOS (Bimuno) produced a very positive effect on both gut microbiota and the immune systems of the elderly. In the elderly, both the immune system and the gut microbiota weaken and deteriorate with age. Reversing those changes in gut microbiota can therefore support the immune system and boost gut health. The results are also applicable to other groups that are affected by immune system deterioration, including those that have used antibiotics, or experienced high levels of stress.

"Whilst advances in global healthcare have led to increased life expectancy, this in turn has led to an increase in the elderly population, one that is vulnerable to a range of health related disorders. Increasing the effectiveness of the immune system in these individuals is therefore an important aid in counteracting the health concerns they can face," said Graham Waters, CEO of Clasado. "This trial is part of a wider program of clinical research in which we are currently engaged, investigating the central role of the gut in a range of health concerns. By investigating the axes between the gut, the brain, and the immune system, Clasado hopes to contribute to future options for patients with under-served medical needs."

Patients readmitted within 30 days were younger and more likely to be African American, and readmitted patients had significantly more comorbidities, such as coronary artery disease, congestive heart disease, peripheral vascular disease, chronic obstructive pulmonary disease, cirrhosis, diabetes mellitus, and metastatic cancer.   In addition, patients with a 30-day readmission had longer durations of hospitalization, more emergency department visits in the 6 months prior to their hospitalization, and were more likely to have Medicaid insurance compared with patients without a 30-day readmission.   There are 2 reasons why a larger number of discharge medications is related to readmission, according to the researchers. First, increasing medication use is likely related to disease severity, which is a good marker for readmission risk; and second, the more medications a patient is prescribed, the less likely the patient will be compliant due to either cost issues, side effects, or inability to keep track of medication use.

Amy Petrinec, lead researcher and a postdoctoral fellow at Case Western Reserve University's Frances Payne Bolton School of Nursing, explains that a stay in an intensive care unit (ICU) does not just affect a patient - it can also affect family members who may need to make important care decisions on behalf of their relative.

In order to cope with the impact of decisions with long-term consequences that they may not understand or not wish to question, family decision-makers can adopt strategies to make the situation better for them.

Avoidant coping is one of three coping styles analyzed by the researchers for the study. This strategy involves not engaging with the decision at all, sometimes using alcohol or drugs to escape from the reality of the situation.

The other coping styles investigated were emotion-focused coping - seeking emotional support from others, making jokes to lighten the mood or attempting to view the situation from a different perspective - and problem-focused coping, whereby the individual seeks further information, makes plans and asks for help.

"We use all of these coping skills to one level or another in different situations," states Petrinec, "but people usually employ one predominant coping strategy in a particular situation."

The researchers then tested the participants for the symptoms of PTSD 60 days after hospital discharge or their relative's death. They found that while adoption of emotion-focused and problem-focused coping decreased over time, the use of avoidant coping remained stable.

Around 42% of the participants exhibited clinically significant PTSD symptoms. The coping strategies adopted 30 days after hospitalization were found to predict later symptoms of PTSD much more effectively than the strategies adopted within days of ICU admission. Death of the relative in question was also a strong predictor of PTSD, regardless of coping style.

In particular, the researchers found using an avoidant coping strategy mediated the relationship between the death of a patient and the severity of PTSD symptoms.

Changes, however, need to be made at the federal and state levels to make telehealth access a reality for all those who might want or need it. First, we must fix outdated licensure and practice rules for health professionals. Traditionally, health care providers are licensed on a state-by-state basis, meaning a physician licensed in my home state of Tennessee cannot practice in neighboring Arkansas. But as telehealth can safely cross borders, requiring duplicate licensure and maintaining separate practice rules in each state will only deny underserved populations access to care, leading to worse long-term health outcomes and decreased worker productivity.

Changes, however, need to be made at the federal and state levels to make telehealth access a reality for all those who might want or need it. First, we must fix outdated licensure and practice rules for health professionals. Traditionally, health care providers are licensed on a state-by-state basis, meaning a physician licensed in my home state of Tennessee cannot practice in neighboring Arkansas. But as telehealth can safely cross borders, requiring duplicate licensure and maintaining separate practice rules in each state will only deny underserved populations access to care, leading to worse long-term health outcomes and decreased worker productivity.

Although Medicare and Medicaid have begun incorporating telehealth technologies, changes to how the programs pay for these services are still needed. Medicare Advantage plans and several Medicare Accountable Care Organizations (ACOs) use telehealth services. There have been several bills introduced in this Congress that would further increase the use of telemedicine, such as allowing Medicare payments for remote patient monitoring in the home (H.R. 3306), providing Medicare coverage for round-the-clock emergency support via telehealth tools (S. 1549), and expanding the use of telemedicine in the TRICARE veterans’ program (H.R. 2725). Additionally, a Senate Finance Committee working group is considering authorizing telehealth for remote monitoring of chronically ill Medicare patients as a part of legislation on chronic care policy changes in Medicare.

But the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. Even in those instances, the beneficiary must already be at a clinic, making care no more convenient.Less than 1 percent of Medicare beneficiaries take advantage of telehealth technologies, despite the potential for long-term savings and improved high-quality access. In fact, a recent Towers Watson studyestimated telehealth could save employers $6 billion a year.

To examine what effects lanosterol might have on cataracts, scientists experimented on dogs with naturally occurring cataracts.

One of the first studies of its kind, released today as a Web First by Health Affairs, examined the length of time new beneficiaries had to wait for primary care appointments in Michigan, a state that expanded eligibility for Medicaid in 2014. The study, by Renuka Tipirneni, Karin Rhodes, Rodney Hayward, Richard Lichtenstein, Elyse Reamer, and Matthew Davis, found that appointment availability increased 6 percentage points for new Medicaid patients and decreased 2 percentage points for new privately insured patients, compared to availability before expansion.

The study was modeled after the simulated patient study (or “secret shopper”) approach recommended by the Department of Health and Human Services (HHS) to examine access to care for new Medicaid patients. Research team members, posing as new patients, called a random sample of approximately 300 primary care practices around the state before and after Michigan’s April 1, 2014, expansion of Medicaid.

“It is noteworthy that Medicaid appointment availability in Michigan increased rather than decreased during a period when approximately 350,000 adults entered the Medicaid system and the number of primary care providers likely remained stable,” concluded the authors. They noted that it was not possible to conclude from this study if new patients with private insurance were being displaced by those with Medicaid, and called for further research to determine “whether increased access to care will persist in Michigan, and whether access to primary care for new patients with Medicaid in other states will follow similar patterns.”

To say Lisa was sick doesn’t really begin to describe her troubles. The 12-year-old was racked by seizures and disabled by strokes from the brain surgery she underwent to remove a tumor. After battling cancer throughout her life, Lisa required “assistance in dressing, eating, and elimination of urine and feces,” as a doctor noted.

She most certainly could not go to school, as the superintendent, principal, and head of special education in her school district were all aware.

“For the past two and a half years of her life, she was in and out of the hospital,” her mother, Martha, said. “She went from being this chatterbox to not talking at all.”

But someone else at the school nevertheless dropped Lisa from enrollment after seeing she had been absent since spring 2012, when she suffered a stroke. By October 2014, Martha was told by the state of Michigan that her application for welfare was denied—because her daughter wasn’t going to school.

“I checked my [benefits] card monthly to see how much I would have, and thought, Why is my amount less? Then I got a letter in the mail,” Martha told The Daily Beast. (She asked that she and her daughter be allowed to use pseudonyms to protect their privacy.)

Michigan kicked Martha, Lisa, and her two siblings off welfare. 

“They’re supposed to be a help department, but I think they actually hurt you more than help you,” Martha said. “I don’t want her death to be in vain. If her situation can help another family, I really want it to be done. I hate to have anyone go through what I went through.”